OBJECTIVES: One third of US adults are obese and it is projected that by 2030 half of US adults will be obese. The study aimed to identify predictors of obesity treatment in ambulatory care settings.
METHODS: National Ambulatory Care Survey (NAMCS) 2006-07, a cross-sectional nationally representative data, was used for the study. A retrospective cohort study design was employed; obese adults, age greater than or equal to 20 years and BMI = 30 kg/m2 or having obesity diagnosis (ICD-9-CM code: 278), were include in the cohort. Obesity treatment included either obesity counseling (diet/nutrition, exercise, weight reduction) or pharmacotherapy (anorexiant or lipase inhibitor). Predisposing, enabling and need characteristics as per Anderson's behavioral model were included as predictor variables. Descriptive statistics and multivariate logistic regression were conducted to identify obesity treatment predictors while preserving complex survey design of NAMCS.
RESULTS: Total of 214 million visits occurred during 2006-07 by obese adults; of which, 32.66% visits resulted in obesity treatment. Factors predicting obesity treatment were reason for visit, preventive visit (OR=2.23; 95% CI=1.50-3.32) and chronic visit (OR=1.93; 95% CI=1.46-2.55) compared to acute visit; time spent with physician, greater than 24 minutes (OR=2.67; 95% CI=1.81-3.94) and 13-24 minutes (OR=1.89; 95% CI=1.26-2.82) compared to 0-12 minutes; high comorbidity (OR=1.46; 95% CI=1.13-1.89); morbidly obese adults i.e. BMI greater than 40 (OR=1.88; 95% CI=1.52-2.34) and visit to primary care physician (OR=2.38; 95% CI=1.69-2.36) compared to specialist. Older adults aged= 65 (OR=0.98; 95% CI=0.97-0.99) and smokers (OR=0.52; 0.39-0.69) had less likelihood of receiving obesity treatment. Gender, race, region and insurance status were not significant predictors of obesity treatment.
CONCLUSIONS: Only one third visits resulted into obesity treatment. Reason for visit, time spent with physician, comorbidity, BMI greater than 40, provider specialty, age and nonsmoking status were significant predictors of obesity treatment. Future research should identify reasons for these observed differences and efforts should be taken to deliver equitable access.
